This is part of a weeklong review of the popular Dr. Atkins high-protein low-carbohydrate diet-style. See Monday's post for an overview. The following is from Dr. Fuhrman's book Eat to Live:

How can you eat all the fat and grease that you want and still lose weight? Humans are primates; genetically and structurally, we closely resemble the gorilla. We are designed, just like the other large primates, to survive predominantly on plant foods rich in carbohydrates. When the human body finds that it does not have enough carbohydrates to run its "machinery" properly, it produces ketones, an emergency fuel that can be utilized in times of crisis.

At rest, the brain consumes about 80 percent of our energy needs. Under normal conditions, the brain can utilize only glucose as fuel. However, the human organism has evolved a remarkable adaptation that enables it to survive for long periods of time without food.

In the first few days of no carbohydrate fuel (food), the body's glucose reserves dwindle and the only way we can produce enough fuel for our hungry brain is by breaking down muscle tissue to manufacture glucose. Glucose cannot be manufactured from fat. Fortunately, our body has a built-in mechanism that allows us to conserve our muscle tissue by metabolizing a more efficient energy source--our fat supply.

After a day or two of not eating, the body dips into its fats reserves to produce ketones as an emergency fuel. As the level of ketones rise in our bloodstream, the brain accepts ketones as an alternative fuel. In this manner, we conserve muscle and increase survival during periods of food deprivation.

Atkins' dietary recommendations prey on his survival mechanism. When we restrict carbohydrates so markedly, the body thinks we care calorically deprived and ketosis results. The body begins to lose fat, even if we are consuming plenty of high-fat foods, as Atkins recommends. Once you start consuming carbohydrate-containing fruits, vegetables, or beans, the ketosis ends and the meat and fat become fattening again. Meat consumption leads to weigh gain, unless you have caused a carbohydrate-deficiency ketosis.

To make matters even worse, you pay an extra penalty from a diet so high in fat and protein to generate a chronic ketosis. Besides the increased cancer risk, your kidneys are placed under greater stress and will age more rapidly. It can take many, many years for such damage to be detected by blood tests. By the time the blood reflects the abnormality, irreversible damage may have already occurred. Blood tests that monitor kidney function typically do not begin to detect problems until more than 90 percent of the kidneys have been destroyed.

Protein is metabolized in the liver, and the nitrogenous wastes generated are broken down and then excreted by the kidney. These wastes must be eliminated for the body to maintain normal purity and a stable state of equilibrium. Most doctors are taught in medial school that a high-protein diet ages the kidney.1 What has been accepted as the normal age-related loss in renal function may really be a cumulative injury secondary to the heavy pressure imposed on the kidney by our high-protein eating habits.2

By the eighth decade of life, Americans lost about 30 percent of their kidney function.3 Many people develop kidney problems at young ages under the high-protein stress. Low-protein diets are routinely used to treat patients with liver and kidney failure.4 A recent multitrial analysis showed that reducing protein intake for patients with kidney disease decreased kidney-related death by about 40 percent.5

Diabetics, who are at increased risk of kidney disease, are extremely sensitive to the stresses a high-protein diet place on the kidney.6 In a large, multicentered study involving 1,521 patients, most of the diabetics who ate too much animal protein had lost over half their kidney function, and almost all the damage was irreversible.7 In my practice, I have seen numerous patients who have experienced significant worsening of their kidney function after attempting weight loss and diabetic control with high protein diets. Coincidence? I think not. Damage from such lopsided nutritional advice can be very serious.

Ketogenic diets, like Atkins, have been used to treat children with seizure disorders when medication alone is unresponsive. Medical studies reveal that these diets can result in serious health consequences. Investigators report a greater potential for adverse events than had ever been anticipated. The dangers of these high-protein diets include hemolytic anemia, abnormal liver function, renal tubular acidosis, and spontaneous bone fractures (despite calcium supplementation).8 Kidney stones are another risk of high protein diets.9 These studies point out that there are many subtle adverse outcomes not being attributed to this dangerous way of eating. One outcome is the Atkins Diet's relative inability to lower cholesterol when compared to my vegetable-based, nutrient-dense diet-style.

Comments (16)Read through and enter the discussion with the form at the end

Susan -
April 4, 2006 4:08 PM

A few years ago I saw a movie on TV (with Meryl Streep) about a family who lost just about everything stuck in the nightmare of having a small child with a seizure disorder, and how they discovered the ketogenic diet and how it saved the child. It turned out that many of the actors in the movie and people associated with the movie had themselves had seizure disorders and been "saved" by the ketogenic diet.

But there has been virtually no publicity on the long term consequences of having gone through a ketogenic regime, nor of any better dietary protocol. ETLers do know how critical the right kind of healthy fats are in young bodies - not the kind from bacon, but rather from avocados. But beyond that, I would love to hear the details on how Dr. Fuhrman would have considered treating young children with such a disorder.

pete bircsak -
April 5, 2006 11:38 AM

It is curious that people like Mr. Truth dont use their own name. I can assure you that at least for me eating the "Eat to Live" way for only a few weeks works wonders . Those that dont believe it should try it.
My results are anecdotal but that is all I need.

Susan -
April 5, 2006 12:22 PM

In the summer before my junior year in high school I was close to 15 pounds overweight and thought I'd try Atkins. This was the mid-70's and Atkins was the fad. I lost the weight all right - and I still wonder just how close I came to losing a kidney! Woke up in the middle of the night with excruciating pain that traveled down. Felt something pass the next morning. The doctor said it was probably a kidney stone.

Even as I struggled with increasing weight for 30 years after I never ever once even considered Atkins again. Not after that pain. I'm so glad to have found ETL.

Dr. Steven Acocella -
April 5, 2006 1:56 PM

Dear Mr. Truth,

Thank you for your thoughtful post. You obviously have an amazing economy with words.

Here's my challenge to you - Do it. Take Susan's position apart piece by piece. Go for it. Put facts behind it. Enlighten us. Expose her damm lies, sentence by sentence. Fill this page with your acumen. The debate will be a healthy one. I for one would love to know what you base your position on. Or have you simply based it upon an eating disorder and the defense of severe food addictions?

Put your facts where your fat is…we're all ears. Or as Bill O'Reily would say…Are you hiding under your desk?!?

There are several points that this saga points up, and which really need to be addressed.

Let us look at Dr Acocella's story of his father's experience first.

The first thing to realise is that, as any scientist will tell you, a study of one isn't much of a study. And this story really doesn't tell us very much.

Although Dr Acocella's father was apparently advised by Dr Robert Atkins, we have no idea what diet his father was actually following. There is a clue, however, in Dr Acocella's description of his mother's obesity. The fact that she was so obese as to be wheelchair bound, tells us that she, at least, was not following a properly constituted low-carb, high-fat diet. It's likely, therefore, unless his mother made two quite different meals for herself and her husband, that Dr Acocella's father, wasn't either.

This story tells us so little that I think we can discount it as having any worth as a basis for serious debate. Just consider the millions of men and women who have heart attacks yet do not follow Atkins. And consider, on the other side, the cultures such as Inuit and Maasai who eat nothing but fat meat, blood and high-fat milk, yet have no heart disease at all.

There are also many other life events which affect the heart as well as general health of which we are told nothing at all.

Now let's look at "How a High-Protein Diet Works" by Dr Joel Fuhrman which contains a number of misconceptions which skew his findings. In the interest of brevity, I'll give just two examples.

Firstly, Dr Fuhrman says:

"By the eighth decade of life, Americans lost about 30 percent of their kidney function. Many people develop kidney problems at young ages under the high-protein stress. Low-protein diets are routinely used to treat patients with liver and kidney failure. A recent multitrial analysis showed that reducing protein intake for patients with kidney disease decreased kidney-related death by about 40 percent.
"Diabetics, who are at increased risk of kidney disease, are extremely sensitive to the stresses a high-protein diet place on the kidney."

So Americans have lost 30% of their kidney function by the age of 80. Were they all on Atkins?

It's certainly true that high protein diets are not good for kidneys with existing disease. But it is important to understand that there is no evidence that healthy kidneys are harmed by a high-protein diet. It is one of the most frequently-repeated criticisms of low-carbohydrate, higher protein diets that they will allegedly lead to kidney failure, despite many studies which have shown such a claim to be completely false.[1-5]

That diabetics should be more at risk is understandable, precisely because they eat the type of diet (high-carb, low-fat) which does damage the kidneys.

There is one other important point. A low-carb diet should not be high-protein; it should be moderate-protein, high-fat, so this caution about 'high-protein' is irrelevant with a properly-constituted low-carb diet.

Secondly, Dr Fuhrman says that "Humans are primates; genetically and structurally, we closely resemble the gorilla. We are designed, just like the other large primates, to survive predominantly on plant foods rich in carbohydrates."

This again is not so. Our gut is very different from a gorilla's. The gorilla is a hind gut digester. It has a very large colon in which bacteria ferment plant material, the products of which are then absorbed. We, on the other hand, have small colons which are designed mainly to extract and conserve water.

The walls of all plant cells are made of cellulose, a form of dietary fibre which is indigestible: There is no enzyme in the human digestive system that will break it down; neither do we have the nutrient absorbing colons of other primates. With no means of breaking down raw plant cell walls, the nutrients inside those cells cannot be digested and absorbed. Passing unaffected straight through the gut, they would be ejected as waste. Our use of plants, even cooked or juiced, is very inefficient. In fact the structure and size of the human gut is right up there with the carnivorous big cats.

But there is more. No primate is a pure herbivore.

Apart from humans, there are 192 other species of primate. Many believe that we are the only one that is eats meat; that all of them except us are vegetarian. But this is demonstrably untrue. Many studies have revealed that all the other primates are actually omnivorous. Never having been persuaded by the arguments of vegetarians, in addition to fruits, nuts, seeds, leaves and flowers, our primate cousins eat birds' eggs, insects, spiders, small animals and even other monkeys.[6,7]

Until Jane Goodall published her research in the 1960s,[8,9] it was assumed that chimpanzees ate only plant foods. But Goodall discovered that they kill and eat monkeys, baby baboons, and other small animals. Dian Fossey and Richard Perry also showed that gibbons, orang-utans, and baboons kill and eat small animals regularly.[10,11] And the most primitive primate of all, the tree shrew, is entirely carnivorous. Studies such as these have led to the reclassification of primates from herbivore to omnivore.

An interesting example of where assumptions such as these can go wrong, involved the National Zoo in Washington. They attempted to breed the Amazon Golden Marmoset monkey in captivity, but failed - until animal protein was added to the monkeys' diet.[12] It had been wrongly assumed that marmosets were complete vegetarians, but we now know that they must have some animal protein in order to be fertile. With the addition of animal protein, they reproduce rapidly in captivity.

Low-carb diets began more than a century before Dr Robert Atkins started to practise medicine. They were remarkably successful - and created the same controversy we see today. This controversy sparked many clinical trials in the Twentieth century which proved their worth in a wide range of diseases.

Dr Atkins, in my opinion, took what was a very healthy diet and ruined it by making it a vehicle to sell his 'nutraceuticals'. But the underlying concept of low-carb, high-fat diets is entirely sound. It is also entirely healthy if it follows natural guidelines and uses real food.

9. Van Lawick-Goodall, Jane. In the Shadow of Man. New York, Houghton Mifflin, 1971, p. 297.
10. Search For the Great Apes. A documentary film on the ethological research on gorillas by Dian Fossey and the ethological research of orang-utans by Birute Galdikas-Brindamour. National Geographic, 1975.

Now let's look at "How a High-Protein Diet Works" by Dr Joel Fuhrman which contains a number of misconceptions which skew his findings. In the interest of brevity, I'll give just two examples.

Firstly, Dr Fuhrman says:

"By the eighth decade of life, Americans lost about 30 percent of their kidney function. Many people develop kidney problems at young ages under the high-protein stress. Low-protein diets are routinely used to treat patients with liver and kidney failure. A recent multitrial analysis showed that reducing protein intake for patients with kidney disease decreased kidney-related death by about 40 percent.
"Diabetics, who are at increased risk of kidney disease, are extremely sensitive to the stresses a high-protein diet place on the kidney."

So Americans have lost 30% of their kidney function by the age of 80. Were they all on Atkins?

It's certainly true that high protein diets are not good for kidneys with existing disease. But it is important to understand that there is no evidence that healthy kidneys are harmed by a high-protein diet. It is one of the most frequently-repeated criticisms of low-carbohydrate, higher protein diets that they will allegedly lead to kidney failure, despite many studies which have shown such a claim to be completely false.[1-5]

That diabetics should be more at risk is understandable, precisely because they eat the type of diet (high-carb, low-fat) which does damage the kidneys.

There is one other important point. A low-carb diet should not be high-protein; it should be moderate-protein, high-fat, so this caution about 'high-protein' is irrelevant with a properly-constituted low-carb diet.

Secondly, Dr Fuhrman says that "Humans are primates; genetically and structurally, we closely resemble the gorilla. We are designed, just like the other large primates, to survive predominantly on plant foods rich in carbohydrates."

This again is not so. Our gut is very different from a gorilla's. The gorilla is a hind gut digester. It has a very large colon in which bacteria ferment plant material, the products of which are then absorbed. We, on the other hand, have small colons which are designed mainly to extract and conserve water.

The walls of all plant cells are made of cellulose, a form of dietary fibre which is indigestible: There is no enzyme in the human digestive system that will break it down; neither do we have the nutrient absorbing colons of other primates. With no means of breaking down raw plant cell walls, the nutrients inside those cells cannot be digested and absorbed. Passing unaffected straight through the gut, they would be ejected as waste. Our use of plants, even cooked or juiced, is very inefficient. In fact the structure and size of the human gut is right up there with the carnivorous big cats.

But there is more. No primate is a pure herbivore.

Apart from humans, there are 192 other species of primate. Many believe that we are the only one that is eats meat; that all of them except us are vegetarian. But this is demonstrably untrue. Many studies have revealed that all the other primates are actually omnivorous. Never having been persuaded by the arguments of vegetarians, in addition to fruits, nuts, seeds, leaves and flowers, our primate cousins eat birds' eggs, insects, spiders, small animals and even other monkeys.[6,7]

Until Jane Goodall published her research in the 1960s,[8,9] it was assumed that chimpanzees ate only plant foods. But Goodall discovered that they kill and eat monkeys, baby baboons, and other small animals. Dian Fossey and Richard Perry also showed that gibbons, orang-utans, and baboons kill and eat small animals regularly.[10,11] And the most primitive primate of all, the tree shrew, is entirely carnivorous. Studies such as these have led to the reclassification of primates from herbivore to omnivore.

An interesting example of where assumptions such as these can go wrong, involved the National Zoo in Washington. They attempted to breed the Amazon Golden Marmoset monkey in captivity, but failed - until animal protein was added to the monkeys' diet.[12] It had been wrongly assumed that marmosets were complete vegetarians, but we now know that they must have some animal protein in order to be fertile. With the addition of animal protein, they reproduce rapidly in captivity.

Low-carb diets began more than a century before Dr Robert Atkins started to practise medicine. They were remarkably successful - and created the same controversy we see today. This controversy sparked many clinical trials in the Twentieth century which proved their worth in a wide range of diseases.

Dr Atkins, in my opinion, took what was a very healthy diet and ruined it by making it a vehicle to sell his 'nutraceuticals'. But the underlying concept of low-carb, high-fat diets is entirely sound. It is also entirely healthy if it follows natural guidelines and uses real food.

9. Van Lawick-Goodall, Jane. In the Shadow of Man. New York, Houghton Mifflin, 1971, p. 297.
10. Search For the Great Apes. A documentary film on the ethological research on gorillas by Dian Fossey and the ethological research of orang-utans by Birute Galdikas-Brindamour. National Geographic, 1975.

I'm not a diet expert, but I know enough to know that saying 'genetically and structurally, we closely resemble the gorilla' and using that simliarity to draw conclusions about the ideal human diet is silly on multiple levels.

First, we *are* closely related to gorillas, but we are much more closely related to bonobos and chimpanzees. I assume that gorillas are mentioned rather than chimpanzees because chimpanzees regularly eat meat and gorillas don't.

Second, even if gorillas were our closest relatives amongst the large primates, it wouldn't imply much about the ideal human diet. If humans were fed a gorilla diet, we'd lose weight al right, on the way to starving. Unlike chimpanzees, who consume lots of fruit, gorillas mostly consume leaves, shoots, and other herbaceous foods which humans can't digest.

Dr. Fuhrman has written a pretty lengthy response to many of these comments. You can read it here: http://tinyurl.com/qxkaa

john doe -
May 2, 2006 2:53 PM

Wow. Dr. BArry Groves is an idiot. I can find quackery stating that eating human feces is the best way to lose weight... You are an idiot and likely not a real doctor. GO AWAY.

TnTPop -
May 19, 2006 10:45 PM

Wow John Doe is a coward. Dr. Barry Groves put out some interesting facts you certainly don't have to agree. As a matter a fact you probably can't come up with any sound way to make a counter point.

mrtruth -
May 30, 2006 1:22 PM

hello again... I dashed off my last comment in state of horror after reading this "article." I had actually forgotten about it, and I am quite suprised it even got printed. at any rate, I just want to thank Barry Groves for doing the hard labor in pointing out just a few inconsistencies. anyway, I'm off to another grass-fed ribeye, enjoy your rice cakes!

I came across this web page doing research for a medication PBA on the ketogenic diet. After reading your responses, I wanted to let you in on something I found. Barry Groves, PhD is published in Neurology magazine, not exactly a quack and a real doctor-Neurology 2000;54(12):2328-30 ... Written By:Barry Groves, PhD.
Check your facts, the other consideration is the form in which a protein is ingested. No other species cooks their meat, and the digestion of cooked meat is what produces dangerous by-products which can lead to heart attacks. I'm not sure about the effects on kidney function of a raw meat diet but DR. Grove's reference to the tribes who healthily consume that diet might be an indicator.

Check out this post for Dr. Fuhrman's thoughts on many of these comments:

Dr. Fuhrman on Dietary Misinformation
(http://tinyurl.com/23voau)

karla -
May 31, 2007 11:04 AM

I dont know much about health related stuff, I'm a 18 years old girl, I went on the atkins diet for 8 months before my prom dance, I follow the diet step by step, and I drop almost 50 pounds, but I had no energy, bad breath, and I smell like a little dog, but that was not the worse part, I started to feel sick of my stomach, when I had blood test my sugar, and cholesterol were fine, but then I had a ecography done the Doctors saw my liver cover in fat, so I had to go in a low fat diet, I gain all the weight back, plus an extra 30 pounds, so as a personal opiniion I will never go back in to an Atkins diet, besides being a very expensive diet, for all the meat, and low carb products you have to buy, simple because is not healthy.

Bill -
May 12, 2008 2:55 PM

TDUNN is exactly correct... for all the information that Dr. Barry Groves gave he forgot to mention the one important fact. Those animals don't sit around a fire and cook the bird's eggs or animal meats that they've killed. And they surely don't slap sauce all over it to make it to taste good. They eat them in their original, unprocessed, unfettered, natural, highly antioxidated stated.

If what this guy is saying is correct then any one of us, including the ribeye clown, should be more than willing to jump over a fence at a farm rip open a cow with our bare hands or primitive tools and have a good time eating a rib with blood and guts all over it. You know, just like the chimpanzees and any other animal. You guys are so tough go eat like a real carnivore. I didn't think so!

If you are unwilling to live like a true carnivore or omnivore then you're better off sticking to an herbivore-like diet with the occasional cooked meat, if you really must have it, as a special occasion meal (i.e. holidays) before the chemically changed meat destroys your internals.

Dr. Gordon's comments goes to show you that most of these doctors have book smarts, but lack common sense. That and they want to make more money from you, and the pharmaceutical industry, as they see you coming in their office with degenerative diseases (cancer, heart disease, diabetes, etc.)

Verimius -
May 27, 2008 8:12 PM

Dear Bill,

There is evidence that humans have been using fire to cook meat for as long as 1.4 million years. That is quite long enough for us to have made the necessary evolutionary adaptations.

Cooking food makes it easier to digest, giving humans a dietary advantage available to no other species.

Understanding this might require book smarts.

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